Telehealth Reimbursement Policies
Telehealth services are becoming widely accepted as a means for providing behavioral health care, which means that telehealth reimbursement policies are constantly changing. All states have some form of private and/or public coverage and reimbursement for mental health services provided via telemedicine. However, state policies for telebehavioral health care vary from state to state.
Private Insurance Coverage
Regulations for telehealth reimbursement by private payers vary from state to state. As of November 2018, 36 states and (including the District of Columbia) have laws that govern private payer telehealth reimbursement policies and four states have proposed bills. Parity laws generally require health insurers to cover and pay for services provided via telehealth the same way they would for services provided through in-person visits. More and more policies are authorizing state-wide coverage for telehealth services, without provider or technology restrictions.
Public Insurance Coverage
Public insurance appears in two different forms: Medicare and Medicaid.
Medicare is health insurance provided by the federal government for people over the age of 65 or people under 65 with certain disabilities or conditions. For telehealth reimbursement, states require real-time audio and video technology for psychiatric services and provider consultations. Like provider licensing laws, reimbursement through Medicare is dependent on the location where the consumer is receiving services, known as the originating site. The originating site must be in a rural location deemed a Health Professional Shortage Area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA). In addition, the originating site must be a medical facility such as a hospital, rural health clinic, federally qualified health center, skilled nursing facility or a community mental health center. This restriction excludes settings such as consumers’ homes.
Medicaid is a state-run insurance program funded primarily by the federal government that assists low-income individuals or families pay for medical care. Eligible recipients pay a small amount for certain health care services while the Medicaid program pays the health care provider. State policies typically determine how telehealth is defined and which types of technologies, services and providers qualify for reimbursement.
As of November 2018, 48 states (including the District of Columbia) have Medicaid programs that offer some form of coverage for telemedicine services. States are increasingly allowing state-wide Medicaid coverage of telemedicine. However, as with Medicare and private insurance, the reimbursement structures for Medicaid vary state to state.